So it’s another 3 A.M morning rush in the Emergency Department. The parents of a 7 month old bring their child in for a fever that it’s had for four days. They have seen us twice and their primary doctor earlier today, and no one can tell them why the child has a fever.Of course the parents didn’t give any fever medicine in the past 6 hours, so of course the child woke up and vomited. Of course none of the physicians before me started any antibiotics. That’s really what the parents wanted. Yes, I know I should have some antibiotic stewardship and not randomly start antibiotics without a treatable source. The child didn’t have an ear infection or a cough or infected urine test, but the child looks great after some motrin given by us. I just want the parents to go away. The child has a virus and will get better eventually with or without our help. At least they vaccinated the child, so it makes meningitis and more obscure diseases less likely. My solution, as the fifth opinion on this child in three days, is to call the diagnosis an ear infection even if I don’t see one and give a shot of antibiotics. It’s like therapeutic acupuncture, and for some reason, it makes the parents think I care and have validated their worries over their child. I also prescribed antibiotics as well for home to give the parents something to do. In fact, I always diagnose ear infections in children even if they don’t have one because inevitably the child will return again to me or someone else within a day or two with a continued fever and the parents will be angry that no ‘medicine’ was started. Who cares about antibiotic resistance anyway? With the AIDS epidemic, antibiotics have been prophylactically used for years! Likewise, it seems that most of our patients have MRSA warnings of resistant-bacteria colonization on them. Patient that have had a prior wound, blood, or urine cultures from prior visits to the hospital with positive results for resistant bacteria will end up with a label of MRSA or some other resistant bacteria on their chart so as to warn everyone to take ‘precautions.’ Of course, many of these patients have multiple visits to the hospital and yet have no ‘real’ medical diagnosis, but during all these visits, they acquire resistant bacteria. They may have a cough, or sore throat, or ankle sprain, or whatever , but every ailment and boo-boo must be prayed, cultured, or cat scanned. If an ailment is minimized by the doctor and a cat scan or blood test isn’t done, then clearly the medical provider is ‘non-caring’ in the eyes of the patient. Satisfaction surveys will be poor for the poor bastard, who then looses his job. Therefore I do blood work, cat scans, initiate antibiotics, and prescribe pain medications with impunity so I can spare my job and not make my ‘clients’ (patients) angry. No complaints at the end of the day is what I want. I don’t want to be sitting in front of an administrator who slaps my wrist because ‘I made a patient mad.’
My next patient came in because she had muscle aches for three weeks and had started a cholesterol medicine a month ago. Of course it is 4 A.M. and she was from another state, visiting friends, so she says. I was forced to do blood work on her to validate her ‘muscle aches.’ In reality, I could have just told her to stop the medicine and go home, but she wanted Percocet, because her pain was a ’30 out of 10′. I hate the fucking pain scale. Everyone always states their pain is more than a 10/10, so I decided to use a clock for a pain scale. If you have more than a 12 pain, then the scale rolls over to a one! IN this particular case, the lady wanted a script for pain pills. She, of course, was allergic to aspirin, motrin, ultram, and anything without Percocet in it.
The night slowly degenerated with burnt out alcoholics coming in by ambulance to be seen for falls, ‘suicidal threats’, or intoxication in public. It just can’t get any better. I don’t fix anyone, I just do damage control, and I get it. I get a pay check. My one lucky break was an intoxicated bastard who left his Perocet out on the gurney. I snagged it to sell to one of my ‘patients.’
I got to see Ashley again in the radiology department so I could decompress myself. We emerged sweaty and panting from the empty changing room after a twenty minute session. It was so awesome to have a ‘quickie’. Ashley wanted one too. Clara mentioned that Ashley was frustrated with Zack, with whom she was spending most nights with. Apparently he was not in relationship mode, but rather was using Ashley for sex….how cruel. She did have an awesome, smooth body. I loved seeing her in knee-chest mode!!!